| NPI | 1841727286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 3375) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AL R-274-TA-B65) |
| Enumeration Date | 2017-05-16 |
| Last Update Date | 2023-03-01 |